Nutritional Status among Children under Five Years in Amman, Jordan

Objectives: There is scarcity of data on malnutrition among children in Jordan. Therefore, this study was conducted to assess the nutritional status and estimate the prevalence rates of stunting, underweight, and wasting and their associated factors among children under five. Subjects and Methods: A cross-sectional study was conducted between January and April 2017 among children under five years in Amman, Jordan. All Jordanian children under five years who visited the selected health centers for vaccination or accompanied their mothers during the study period were included in this study. Mothers or caregivers of children were interviewed face-to face using the study questionnaire. Weight in kilograms and height in centimeters were measured for all children. Anthropometric indices were calculated using reference medians recommended by the World Health Organization. Results: This study included a total of 923 (463 boys and 460 girls) children. The prevalence rates of stunting, underweight, and wasting were 6.2%, 3.8%, and 2.8%, respectively. Multivariate analysis showed that low birth weight was significantly associated with stunting (OR = 2.9, 95% CI: 1.4,6.0; p-value=0.003) and underweight (OR =5.6, 95% CI: 2.5,12.3, p-value <0.001). Compared to exclusive breastfeeding, mixed feeding was associated with increased odds of stunting (OR =2, 95% CI: 1.1-3.9, p-value =0.029) and underweight (OR = 2.2, 95% CI: 1.002, 5.0; p = 0.049). None of the variables were significantly associated with wasting. Conclusions: The prevalence rates of stunting, wasting and undernutrition among children under five years in Jordan are low. Low birth weight and mixed feeding were associated with higher rates of malnutrition

Liraglutide effects on glycemic control and weight in patients with Type 2 Diabetes mellitus: a real-world, observational study and brief narrative review

Background Glycemic control and weight gain are two essential considerations in the pharmacological management of type 2 diabetes mellitus. Pharmacological agents are effective in lowering blood glucose levels but may result in significant weight gain. Liraglutide effectively maintains glycemic control while reducing weight. Methods This is a real-world study and brief narrative review of the effects of liraglutide on glycemic control and weight in adult patients with type 2 diabetes mellitus. The study uses data extracted from the electronic health record of the Ministry of National Guard-Health Affairs. Results In this study of 348 subjects, there was a statistically significant reduction in hemoglobin A1c of 0.9% (P < .0001) and weight of 2.3 kg (P < .0001). The majority (77.3%) were on concomitant insulin. Subjects with a baseline hemoglobin A1c greater than 9% had a significantly greater reduction than those below 9% (−0.7%; P < .0001). Those with a weight more than 100 kg had a significantly greater reduction than those below 100 kg (-0.9 kg; P = .0096). Conclusion In this real-world, observational study, liraglutide was shown to be effective in improving glycemic control and reducing weight in adult patients with type 2 diabetes mellitus

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research